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Only 41 percent of college students say misusing prescription stimulants for academic purposes should be considered cheating, according to a survey at an unnamed Ivy League institution. The survey found 18 percent of students said they misused stimulant drugs in an attempt to gain an academic advantage at least once in college.

Of students who used stimulant drugs, 24 percent said they had done so eight or more times, Inside Higher Ed reports. While 33 percent of students did not think using drugs such as Adderall or Ritalin was cheating, 25 percent were unsure, and 41 percent considered it cheating.

“While many colleges address alcohol and illicit drug abuse in their health and wellness campaigns, most have not addressed prescription stimulant misuse for academic purposes,” researcher Andrew Adesman of Steven and Alexandra Cohen Children’s Medical Center of New York, said in a news release. “Because many students are misusing prescription stimulants for academic, not recreational purposes, colleges must develop specific programs to address this issue.”

The study included 616 college students without attention deficit hyperactivity disorder who completed an anonymous online questionnaire. More students who played a varsity sport and were affiliated with a Greek house said they misused stimulants, compared with students affiliated with only one or neither.

The findings were presented at the Pediatric Academic Societies annual meeting.